What is a Copayment?

A fixed amount that the participant pays for a covered service, usually when the service is received. The amount varies by plan type.

What is a Deductible?

The amount a participant pays prior to the time the insurer starts to pay unless the plan offers a co-payment arrangement.

What is Coinsurance?

The portion of the claims liability that is shared between the participant and WEBT. WEBT uses a percentage method of 80%/20% to $7,500 with each participant being liable for $1,500 and WEBT liable for $6,000 after the deductible has been met.

What is a Medical Cost Share Maximum Amount?

The total coinsurance and medical copayment amounts for covered services that are a participant's responsibility during a single calendar year.

What is a Medical Out-of-Pocket Maximum Amount?

The total deductible and medical cost share maximum amounts for covered services that are a participant's responsibility during a single calendar year.

What is a Pharmacy Out-of-Pocket Maximum Amount?

The total copayment and coinsurance amounts for covered services that are a participant's responsibility under the prescription drug benefit during a calendar year.

When does my deductible and coinsurance start and end?

The deductible and coinsurance are on a calendar year basis, from January 1, to December 31.

Do emergency room charges apply toward the deductible and coinsurance?

Do I have to get a referral to see a specialist?

No, WEBT does not require a referral to see a specialist. However, the specialist may require a referral from your primary care provider.

Will WEBT cover my pre-existing condition?

WEBT does not exclude any pre-existing conditions, including employee or spousal pregnancies.

When can I change my deductible option?

If your employer offers more than one option to its employees, then you may change your deductible option during the month of May for a July 1 effective date. Contact your employer for appropriate paperwork.

What are the benefits of using an in-network provider versus an out-of-network provider?

In-Network:

Provide services to participants at a reduced cost

File claims on behalf of participants

Cannot balance bill for charges above the contracted allowance

Out-of-Network:

Services provided may cost the participant more

Does not file claims on behalf of participants

Is able to balance bill for charges above the contracted allowance

Services provided may not be covered or only partially covered

Who is eligible for maternity coverage?

Covered employees and covered spouses are eligible for maternity coverage. Dependent children are not eligible for maternity coverage.

Does WEBT cover MRIs?

MRIs are covered subject to deductible and coinsurance. However, if more than one MRI is performed on the same day, then benefits for the technical component will be limited to 50% of the allowable charge for each MRI after the first.

Who do I contact when I want to add, change or end coverage?

Please contact your human resources department regarding all changes.

When do I add my spouse due to marriage?

The new spouse will be effective on the date of the legally recognized marriage, provided that the application, along with documentation verifying the marriage, is received by the employer within thirty (30) days after the date of the marriage.

When do I add my newborn child to my coverage?

Newborn children will be effective on the date of birth, provided that the completed application for coverage of the newborn child is received by the employer within sixty-one (61) days of the child's date of birth.

When does coverage end for my spouse due to divorce?

Coverage will end the end of the month following a final divorce decree or legal separation.

How long can my dependent children remain on my policy?

The end of the month in which a dependent child attains age twenty-six (26).

What is COBRA?

COBRA is a continuation of your current benefits. Participants may qualify for continued coverage under this plan for 18 months. The cost of the coverage is the responsibility of the participant and the rate will be 2% higher than the current rate.

What is open enrollment?

Open enrollment is the period of time where individuals that did not enroll during their initial eligibility may enroll without a qualifying event. For WEBT, this occurs every November for an effective date of the following January 1st. Please contact your employer for appropriate paperwork.